Transoral endoscopic thyroid surgery via the tri‐vestibular approach with a hybrid space‐maintaining method: A preliminary report

Wang, Yong; Zhang, Ziyi; Zhao, Qi; Xie, Qiuping; Yan, Haichao; Xing, Yu; Cheng, Xiang; Zhang, Maolin; Wang, Ping

doi:10.1002/hed.25157

Cited by 21 publications

(14 citation statements)

References 14 publications

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“…Although the results of this group were comparable to those of the rest of the groups that used insufflation, the technique has been criticized as going against the scarless concept of the transoral technique, because several small stab incisions were needed to anchor the wires in the skin. Wang et al 42 described a hybrid method in which the surgical working space is kept open by combining a cosmetically acceptable suspensory mechanism with carbon dioxide insufflation. Data regarding the outcomes of this technique are limited; further research is needed to assess its feasibility.…”

Section: Discussionmentioning

confidence: 99%

Transoral Endoscopic Thyroidectomy: A Systematic Review of the Practice So Far

Camenzuli

Schembri-Wismayer

Calleja‐Agius

2018

JSLS

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Background and Objectives:Thyroid disease largely affects young females, but the incidence is also increasing among males. In an effort to avoid the scarring of the neck that is synonymous with conventional thyroidectomy, endoscopic techniques have been developed over the years. The transoral endoscopic approach is the latest of these innovations that promises a scarless surgical outcome. This review evaluates whether this technique is safe and feasible in live patients and outlines the outcomes in published literature so far.Database:PubMed, Medline, BioMed Central, Cochrane Library, OVID and Web of Science were systematically searched by using a Medical Subject Heading (MeSH)–optimized search strategy. The selection of papers followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines after setting strict inclusion and exclusion criteria. Sixteen studies were included in the final analysis.Discussion:This systematic review presents cases of 785 patients. Surgeons in 15 of the studies used a completely vestibular approach, whereas those in the remaining 2 used the floor of the mouth for primary access. Conversion to open surgery took place in 1.3%. In total, 4.3% of patients experienced transient laryngeal nerve palsy, whereas 0.1% had permanent recurrent incidences of the condition. Transient hypocalcemia occurred in 7.4% of cases, with no recorded permanent cases. Carbon dioxide embolism occurred in 0.6% of cases, and another 0.6% had a deep-seated neck infection. The complication rates within the review were deemed acceptable and the overall technique feasible. A prospective randomized controlled trial was proposed to compare this technique with conventional thyroidectomy.

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Section: Discussionmentioning

confidence: 99%

Transoral Endoscopic Thyroidectomy: A Systematic Review of the Practice So Far

Camenzuli

Schembri-Wismayer

Calleja‐Agius

2018

JSLS

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“…11 TOETVA is considered as a minimally invasive surgery with no cutaneous scar and shorter tissue dissection. 9,11 Recently, increasing evidence has investigated the safety and feasibility of the TOETVA with a paucity of comparative studies. [9][10][11][12][13] Although a few studies have directly compared TOETVA and COT, [14][15][16][17][18][19][20] it has failed to reach a consensus whether TOETVA is safe and feasible for thyroid lesions because of small number of sample size and assessment at a single institution.…”

Section: Introductionmentioning

confidence: 99%

“…Due to the noticeable scar on the anterior neck caused by COT and increasingly cosmetic requirements, 1,2 especially in women, a variety of endoscopic thyroidectomy (ET) approaches have been developed, such as subclavian, 3 areola, 4 breast, 5 axillary, 6 axillo‐breast, 7 and dorsal approach 8 . However, concerns were also raised as these approaches may associate with an extensive flap dissection, scar hyperplasia at the incision sites, and difficulties in dissecting the lower part of central lymph node 9,10 . Along with the emergence of natural orifice transluminal endoscopic surgery (NOTES) and development of endoscopic instruments, transoral endoscopic thyroidectomy vestibular approach (TOETVA) has been rapidly developed for patients with benign thyroid nodules and selected differential thyroid carcinomas 11 .…”

Section: Introductionmentioning

confidence: 99%

“…Along with the emergence of natural orifice transluminal endoscopic surgery (NOTES) and development of endoscopic instruments, transoral endoscopic thyroidectomy vestibular approach (TOETVA) has been rapidly developed for patients with benign thyroid nodules and selected differential thyroid carcinomas 11 . TOETVA is considered as a minimally invasive surgery with no cutaneous scar and shorter tissue dissection 9,11 …”

Section: Introductionmentioning

confidence: 99%

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Transoral endoscopic thyroidectomy vestibular approach vs conventional open thyroidectomy: Meta‐analysis

et al. 2020

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Background: To conduct a meta-analysis to compare the safety and efficacy of transoral endoscopic thyroidectomy vestibular approach (TOETVA) with conventional open thyroidectomy (COT). Methods: MEDLINE, EMBASE, Science Citation Index Expanded, and the Cochrane Central Register of Controlled Trials in the Cochrane Library from January 2007 to March 2020 were searched to identify studies comparing TOETVA and COT. Results: Six eligible nonrandomized studies involving 1151 patients were included. Meta-analysis results revealed that TOETVA group had a significantly longer operative time (weighted mean difference [WMD], 66.09; 95% confidence interval [CI], 35.22-96.96; P < .0001) and larger amount of drainage (WMD, 98; 95% CI, 20.14-175.86; P = .01). There were no significant differences in terms of postoperative outcomes. Conclusion: TOETVA appears to be as feasible and safe as the COT for the treatment of patients with benign thyroid nodules and selected differential thyroid carcinomas.

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“… 1 To date, nearly 700 cases have been described within the literature successfully utilizing the technique. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 As more surgeons and institutions adopt the approach, it is important to establish a framework for implementation that ensures patient safety. 15 Considerations include: strong administrative support, case observation and cadaveric dissection, appropriate patient selection, and awareness of the expected learning curve.…”

Section: Introductionmentioning

confidence: 99%

The role of surgeon‐performed ultrasound in transoral endoscopic thyroidectomy vestibular approach (TOETVA)

Razavi¹,

Shaear²,

Anuwong

et al. 2020

World j. otorhinolaryngol.-head neck surg.

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Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) is a recently described surgical technique where the thyroid and central neck can be accessed without a cutaneous incision. To date nearly 700 cases have been described within the English literature demonstrating the feasibility, safety, and efficacy of the technique. As more institutions begin to adopt the surgical approach, it is important that surgeons pay close attention to appropriate patient selection and surgical optimization to prevent experience-related complications. A valuable tool to facilitate these considerations is the utilization of surgeon-performed ultrasonography (US). While the merits of surgeon-performed US are well-documented within head & neck endocrine surgery as a whole, its value may be of even greater importance when implementing a novel surgical technique such as TOETVA. Here we highlight and summarize the role of surgeon-performed US within head & neck endocrine surgery, focusing on how it may influence patient selection and surgical planning with TOETVA.

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Transoral endoscopic thyroid surgery via the tri‐vestibular approach with a hybrid space‐maintaining method: A preliminary report

Abstract: This approach brings satisfactory cosmetic effect along with minimal invasion. Further study is needed to verify its validity.

Cited by 21 publications

References 14 publications

Transoral Endoscopic Thyroidectomy: A Systematic Review of the Practice So Far

Transoral Endoscopic Thyroidectomy: A Systematic Review of the Practice So Far

Transoral endoscopic thyroidectomy vestibular approach vs conventional open thyroidectomy: Meta‐analysis

The role of surgeon‐performed ultrasound in transoral endoscopic thyroidectomy vestibular approach (TOETVA)

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